Pre-operative Assessment of Ovarian Tumor in Patients Presenting with Adnexal Mass on the Basis of Risk of Malignancy Index (RMI)

Background:Ovarian cancer is the second most common gynaecologic cancer in developing countries. Five-year survival of ovarian cancer varies according to stages, hence, screening, detection and treatment in earlier stages are of great importance. The Scottish Intercollegiate Guidelines Network (SIGN) recommends use of Risk of Malignancy Index (RMI) for preoperative assessment of ovarian tumours. It is a scoring system based on menopausal status, ultrasound findings, and serum CA 125 level in adnexal mass.Objective:To investigate the accuracy of RMI as a predictive method of discriminating benign from malignant ovarian tumour.Methodology: Fifty patients, 30 years or older, with adnexal mass, admitted for laparotomy in Obstetrics and Gynaecology Dept. from April’13 to September’13were randomly assigned in this cross-sectional descriptive study. RMI was calculated for each patient based on menopausal status, CA125 level and ultrasound findings of bilateral lesion, multilocular cyst, solid areas, ascites and metastases.Results:Among 50 women, 18 cases (36%) were postmenopausal showing more malignant tumors (77.78%) in this group. Depending on histopathological reports, 82% benign and 18% malignant diseases.The best performance of RMI was obtained at cut-off value of 230 with sensitivity of 100%, specificity of 95.2%, positive predictive value (PPV) of 80% and negative predictive value (NPV) 100%. Conclusion:Compared to previous studies, RMI was highly sensitive in detecting malignant disease, though not as specific in excluding benign lesions, particularly endometriosis.J Shaheed Suhrawardy Med Coll, December 2017, Vol.9(2); 69-73

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Evaluation of Adnexal Masses-Correlation of Clinical, Sonological and Histological Findings in Adnexal Masses

Nepal Medical College Journal ◽

10.3126/nmcj.v22i4.34180 ◽

2020 ◽

Vol 22 (4) ◽

pp. 199-202

Author(s):

Manisha Acharya ◽

P Kumar ◽

BB Shrestha ◽

S Shrestha ◽

R Amatya ◽

...

Keyword(s):

Predictive Value ◽

Adnexal Mass ◽

Diagnostic Value ◽

Mean Value ◽

Ca 125 ◽

Histopathological Diagnosis ◽

Adnexal Masses ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index ◽

Clinical Records

Adnexal mass is a common clinical finding in gynaecological practice. The study aims to find out the diagnostic value of clinical examination, ultrasonography and Ca-125 and its correlation, using Risk of Malignancy Index with histopathological diagnosis in adnexal masses. Clinical records were retrieved of women who had surgical management for adnexal mass in the last 2 years duration. Based on the data, Risk of Malignancy Index values were calculated. It was then compared with histopathological diagnosis. Out of 66 patients, 56 patients had benign tumor and 10 patients had malignancy. The Risk of Malignancy Index values of each patient was calculated which ranged from 8 to 2205 with mean value of 425.52 (SD±41.8). Risk of Malignancy Index sensitivity was 70%, specificity was 96.42%, positive predictive value was 77.78%, and negative predictive value was 95.83%. Risk of Malignancy Index is a reliable diagnostic tool in differentiating benign from malignant adnexal masses.

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ONCOGYNECOLOGICAL ASPECTS ОF ADNEXAL MASSES

Annals of the Russian academy of medical sciences ◽

10.15690/vramn.v68i8.716 ◽

2013 ◽

Vol 68 (8) ◽

pp. 9-13 ◽

Cited By ~ 3

Author(s):

A. S. Gasparov ◽

K. I. Zhordania ◽

Yu. G. Payanidi ◽

E. D. Dubinskaya

Keyword(s):

Malignant Tumors ◽

Menopausal Status ◽

Pelvic Mass ◽

Serous Cystadenoma ◽

Ca 125 ◽

Adnexal Masses ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index ◽

Benign Ovarian Tumors ◽

Reproductive Aged Women

Adnexal masses are frequently found in both symptomatic and asymptomatic women. The frequency of them is 7,8% in reproductive aged women and 2,5–18% in postmenopausal patients. Aim: to investigate clinical significance of the Risk of Malignancy Index (RMI) and to compare it with histological findings in patients with adnexal masses. Patients and methods: 345 patients with adnexal masses were evaluated. Depending on the menopausal status, serum CA-125 level and ultrasonographic findings RMI scores were calculated for each of patients. Results: according to RMI all the patients were divided in to two groups: first group — 283 (62%) of patients with RMI less then 200 and the second group — 52 (38%) women with RMI more then 200. The patients of the second group were referred to the oncologist. Among the patients with RMI 200, 137 (48,4%) endometriomas, 73 (25,8%) serous cystadenoma, 45 (15,9%) dermoid cysts, 22 (7,8%) paraovarian cysts, 2 (0,7%) adenocarcinoma were detected after histological examination. In patients with RMI 200, 25% of benign ovarian tumors, 34,6% of borderline and 40,4% of malignant tumors were verified. Conclusions: RMI when used in the presence of a pelvic mass is a useful triage tool to determine those women who should be referred to a gynaecological oncologist. During laparoscopy, in cases of intraoperative malignancy suspicion staging should be performed: videorecord of the surgery, biopsy of the adnexal mass and contralateral ovary, biopsy of the omentum and peritoneum, and aspiration of the peritoneal fluid for cytological examination.

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Role of risk of malignancy index 4 in evaluation of adnexal masses

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20203863 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3818

Author(s):

Amarjeet Kaur ◽

Sujata Sharma ◽

Sohan Singh

Keyword(s):

Predictive Value ◽

Malignant Disease ◽

Adnexal Mass ◽

Cost Effective ◽

Benign Disease ◽

Ca 125 ◽

P Value ◽

Adnexal Masses ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index

Background: The discrimination between benign and malignant adnexal masses is important for clinical management and surgical planning in such patients. Various combined methods of evaluation adnexal mass have also been proposed. Risk of malignancy index (RMI) is a combined parameter which is simple, preclinical and highly sensitive, and more specific. Risk of malignancy index 4 (RMI 4) is calculated as a product of ultrasound score (U)×menopausal score (M)×CA 125×tumor size. Objective of this study was to determine if the RMI (RMI 4) can distinguish between benign and malignant adnexal masses.Methods: A prospective study was conducted on 30 women with an adnexal mass presenting in the OPD and emergency and RMI-4 calculated. Cut off level of 450 was set to differentiate between benign and malignant mass.Results: In this study, the value of RMI-4 is less than 450 in 17 patients with benign disease and 3 patients with malignant disease. The value is more than 450 in 2 patients with benign disease and 8 patients with malignant disease. RMI-4 >450 had a sensitivity of 72.73% and specificity is 89.47%. The positive predictive value is 80% and negative predictive value is 85%. The p-value for RMI-4 in this study is 0.001 which is highly significant.Conclusions: RMI is a reliable, simple, easy to use and cost-effective method in differentiating benign from malignant adnexal masses.

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Role of risk of malignancy index for evaluation and preoperative detection of pelvic malignancies compared with pathological diagnosis

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20203510 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3611

Author(s):

Beenish Yousseff ◽

Mariya Amin Qurieshi ◽

Nadiya Yousseff

Keyword(s):

Predictive Value ◽

Menopausal Status ◽

Histopathological Diagnosis ◽

Ovarian Malignancy ◽

Cross Sectional ◽

Jammu And Kashmir ◽

Pelvic Malignancies ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index ◽

Ultrasound Score

Background: Risk of malignancy index (RMI) is widely employed in the developed world in predicting malignant pelvic masses. The present study designed to confirm the effectiveness of the RMI to identify cases with high potential of ovarian malignancy, among patients with an adnexal mass.Methods: This was a cross-sectional study was conducted over a period of two years in a government run tertiary healthcare centre of Srinagar, Kashmir, Jammu and Kashmir, India. Study included 72 patients who underwent surgery due to adnexal mass and were evaluated for ovarian malignancy by comparing RMI with histopathological diagnosis. Data collected included demographic characteristics, ultrasound findings, menopausal status, CA125 levels, and histopathological diagnosis. For each patient, RMI was calculated as per the standard formula.Results: Analysis revealed ultrasound score had the highest sensitivity of 72.7%, while an RMI score ≥250 had the highest specificity of 88.5%. The latter also had the highest positive predictive value of 50%, while negative predictive value was highest for an ultrasound score of 3 (94%). The cut off points based on ROC analysis demonstrates significant predictive ability for ovarian cancer for both RMI and CA125 with AUC to the tune of 82.9% and 80.1% respectively.Conclusions: RMI is a simple score system which can be applied directly into clinical practice and might be of value in pre-operative assessment, and hence selecting patients who need surgical team including gynecologic oncologists.

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Risk of malignancy index 4 in preoperative evaluation of patients with ovarian tumours

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20182370 ◽

2018 ◽

Vol 7 (6) ◽

pp. 2467

Author(s):

Sunita Singhal ◽

Lata Rajoria ◽

Premlata Mital ◽

Alka Batar ◽

Richa Ainani ◽

...

Keyword(s):

Predictive Value ◽

Ovarian Tumor ◽

Preoperative Evaluation ◽

Menopausal Status ◽

Ovarian Tumour ◽

Ca 125 ◽

Benign Ovarian Tumor ◽

Ovarian Tumours ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index

Background: Ovarian tumors usually presents as adnexal masses which may be benign or malignant. Accurate and timely diagnosis of an adnexal mass is a challenge for the gynecologists. Currently clinical examination, ultrasonographic assessment and ovarian tumour markers (CA 125, beta hCG, AFP, LDH) are routinely done at our centre to evaluate patients with ovarian tumours. The study was designed to evaluate the ability of RMI 4 to discriminate benign ovarian tumor from malignant ovarian tumor in patients attending Department of Obstetrics and Gynaecology, S.M.S. Medical College, Jaipur.Methods: 200 patients diagnosed to have ovarian tumours were included in the study after obtaining written consent. Ultrasonographic characteristic, menopausal status and serum CA 125 levels were documented preoperatively. Risk of malignancy index 4 was calculated and correlated with histopathological diagnosis.Results: At a cut-off point of 450, RMI 4 had a sensitivity of 67.5% (95% CI: 50.87-81.43%), specificity of 98.75% (95.56-99.85%), positive likelyhood ratio of 54, negative likelyhood ratio of 0.33, a positive predictive value of 93.1%, negative predictive value of 92.4% and diagnostic accuracy of 92.5%.Conclusions: RMI 4 is a simple, cost effective, reliable scoring system that is easily applicable method in primary evaluation of patients with ovarian tumours with a sensitivity of 67.5% and specificity of 98.75%.

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Evaluation of risk malignancy index in the pre-operative diagnosis of benign and malignant ovarian neoplasms

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20183303 ◽

2018 ◽

Vol 7 (8) ◽

pp. 3126

Author(s):

Niroopama Pushpagiri ◽

Saranya Nagalingam

Keyword(s):

Predictive Value ◽

Ovarian Neoplasms ◽

Menopausal Status ◽

Tertiary Care ◽

Ca 125 ◽

Predictive Values ◽

Medical College ◽

Ovarian Tumours ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index

Background: Preoperative discrimination between benign and malignant ovarian neoplasm is necessary to optimally plan for an appropriate surgical treatment. Women with malignant ovarian tumours should be referred to a gynaecologic oncologist for the quality of cytoreductive surgery leading to increased survival. The aim of this study is to determine the role of Risk of Malignancy Index (RMI) incorporating menopausal status, serum CA 125 levels and ultrasound features in discriminating benign from malignant ovarian neoplasms.Methods: A prospective cohort study was conducted for 2 years among 110 women with ovarian neoplasms referred to Narayana Medical College and Hospital, Nellore a tertiary care centre for diagnosis and management. The sensitivity, specificity, positive and negative predictive values of menopausal status, ultrasound finding of ovarian neoplasms, levels of serum CA-125 separately and combined into the RMI were calculated and compared. (RMI = U X M X Serum CA- 125). Women of all ages admitted with ovarian masses in Narayana Medical College, Nellore. Women whose histopathology report turned out to be non-neoplastic ovarian tumours or other adnexal masses.Results: RMI >250 had a sensitivity of 70.8 % (95%CI 54.4-87.2), a specificity of 87% (95%CI 76.5-97.7), a positive predictive value of 81 % and negative predictive value of 79.4% for the diagnosis of malignant neoplasms.Conclusions: The risk of malignancy index is a simple scoring system and easily applicable and effective method for evaluating a patient in discriminating benign and malignant ovarian neoplasms efficiently to optimize therapy. It facilitates timely referral to gynecological oncology unit for adequate staging and optimal debulking.

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The role of Risk of Malignancy Index (RMI) based on serum CA-125 level, ultrasound score and menopausal status in pre-operative evaluation of adnexal mass

Journal of Clinical Oncology ◽

10.1200/jco.2008.26.15_suppl.16578 ◽

2008 ◽

Vol 26 (15_suppl) ◽

pp. 16578-16578

Author(s):

J. Pariyar

Keyword(s):

Adnexal Mass ◽

Menopausal Status ◽

Ca 125 ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index ◽

Operative Evaluation ◽

Ultrasound Score

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A prospective observational study on the effectiveness of risk of malignancy index score (RMI 3) in a tertiary care centre in Eastern India

Asian Journal of Medical Sciences ◽

10.3126/ajms.v11i5.29548 ◽

2020 ◽

Vol 11 (5) ◽

pp. 54-60

Author(s):

Apurba Mandal ◽

Shibram Chattopadhyay ◽

Sushanta Mondal ◽

Arunava Biswas

Keyword(s):

Ovarian Cancer ◽

Adnexal Mass ◽

Malignant Tumors ◽

Histopathological Examination ◽

Tertiary Care ◽

Ca 125 ◽

Tertiary Care Centre ◽

Gynecology And Obstetrics ◽

Risk Of Malignancy ◽

Malignant Lesions

Background: Adnexal mass is a common presentation in today’s gynecological practice. The incidence of ovarian cancer is increasing day by day and diagnosis is often difficult to be made pre operatively with inadequate surgical exploration is a regular occurrence. Aims and Objectives: To assess and validate the importance of RMI-3 score as pre-operative diagnostic tool of differentiating benign from malignant adnexal mass for starting first line therapy of ovarian cancer and to find out the incidences of ovarian malignancy among study population. Material and Methods: The study was conducted in the Department of Gynecology and Obstetrics on (n=115) patients attending GOPD and indoor with adnexal mass fulfilling the inclusion and exclusion criteria using purposive sampling technique. All the selected cases underwent ultrasonography and serum CA- 125 level estimation necessary for calculating RMI score. A score of >200 was taken as suggestive of malignancy and confirmatory diagnosis was performed by histopathological examination obtained from staging laparotomy of adnexal mass. The individual scores were then correlated with final outcomes with statistical analyses. Results: The study revealed benign ovarian tumors are more under 50 years (78.46%) and patients with normal BMI are diagnosed with maximum of malignancy (n = 28). History of tubal ligation carried less risk of malignancy (p<0.0001). Histologically malignant tumors found mostly in 71.4% postmenopausal group whereas 94.1% benign pathology were present in perimenopausal group and there is no association found between parity and histopathology (p=0.058). Bilateral (p=0.013), multilocular (p=0.000) tumors with solid areas (p<0.0001) and thick papillary projections (p<0.0001) had statistically significant association with malignant lesions. RMI score (>200) had more efficacy than serum CA-125 level (>46) in differentiating malignant lesions from benign one in terms of specificity (96% vs 83.87%) and positive predictive value (95% vs 79.17%). Conclusions: RMI-3 score is a simple, reliable and effective tool in differentiating benign from malignant adnexal masses thereby help in quick referral and management of cases with increase chances of survival of the patients.

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Role of human epididymis protein 4 for detection of ovarian carcinoma in adnexal masses: A pilot study

10.1055/s-0039-1685305 ◽

2016 ◽

Author(s):

Nidhi Bansal ◽

A. Suneja ◽

K. Guleria ◽

N. B. Vaid ◽

K. Mishra ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Cross Sectional Study ◽

Ca 125 ◽

Serum Samples ◽

Cross Sectional ◽

Adnexal Masses ◽

Good Discriminator ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index ◽

Benign Tumours

Introduction: HE4 is a novel tumour biomarker used for early diagnosis of ovarian cancer. This study evaluated the diagnostic accuracy of HE4 alone and in combination with CA125, risk of malignancy index (RMI), risk of malignancy algorithm (ROMA). Methods: It was a cross sectional study conducted recruiting 88 women with adnexal masses who were planned for surgery. After baseline work up and ultrasound examination, serum samples were collected for estimation of CA 125 and HE4 levels. Serum HE4 levels were estimated using ELISA kit. RMI and ROMA score were calculated and diagnostic accuracy of HE4, CA 125, RMI, ROMA and their combination were compared. Cut off for HE4 and ROMA score were calculated using ROC curve. Results: Of 88 subjects, 66 were analyzed with 19 malignant (including 5 LMP) and 47 benign cases. The median value of HE4 among malignant cases was found to be significantly higher than among the benign cases. PPV and NPV of HE4 at a cut off 130.8 pMol/ml was 85.7% and 77.9% respectively. Highest PPV (88.9%) with acceptable NPV (80.7%) was found with ROMA followed by HE4 (PPV 85.7%; NPV 77.97%), RMI (PPV 76.92%; NPV 83%) and CA125 (PPV 52%; NPV 80.85%). Conclusion: HE4 levels were lower in Indian population both in malignant and benign tumours as compared to other studies. HE4 is a good discriminator and gives best accuracy when it is combined with CA125 in a logistic algorithm, ROMA.

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